Miscarriage

Topic Overview

Is this topic for you?

This topic is about the
loss of a baby before 20 weeks of pregnancy. For information about the loss of
a baby after 20 weeks of pregnancy but before the baby is born, see the topic
Stillbirth.

What is a miscarriage?

A miscarriage is the loss
of a pregnancy during the first 20 weeks. It is usually your body's way of
ending a pregnancy that has had a bad start. The loss of a pregnancy can be
very hard to accept. You may wonder why it happened or blame yourself. But a
miscarriage is no one's fault, and you can't prevent it.

Miscarriages are very common. For women who already know they are pregnant,
about 1 out of 6 have a miscarriage.1 It is also
common for a woman to have a miscarriage before she even knows that she is
pregnant.

What causes a miscarriage?

Most miscarriages
happen because the fertilized egg in the uterus does not develop normally. A
miscarriage is not caused by stress, exercise, or sex.
In many cases, doctors don't know what caused the miscarriage.

The risk of miscarriage is lower after the first 12 weeks of the
pregnancy.

What are the common symptoms?

Common signs of a
miscarriage include:

Bleeding from the vagina. The bleeding may be
light or heavy, constant or off and on. It can sometimes be hard to know
whether light bleeding is a sign of miscarriage. But if you have bleeding with
pain, the chance of a miscarriage is higher.

Pain in the belly,
lower back, or pelvis.

Tissue that passes from the vagina.

How is a miscarriage diagnosed?

Call your doctor
if you think you are having a miscarriage. If your symptoms and a pelvic exam
do not show whether you are having a miscarriage, your doctor can do tests to
see if you are still pregnant.

How is it treated?

No treatment can stop a
miscarriage. As long as you do not have heavy blood loss, a fever, weakness, or
other signs of infection, you can let a miscarriage follow its own course. This
can take several days.

If you have
Rh-negative blood, you will need a shot of Rhogam.
This
prevents problems in future pregnancies. If you have not had
your blood type checked, you will need a blood test to find out if you are
Rh-negative.

Many miscarriages complete on their own. But
sometimes treatment is needed. If you are having a miscarriage, work with your
doctor to watch for and prevent problems. If the uterus does not clear quickly
enough, you could lose too much blood or develop an infection. In this case,
medicine or a procedure called a
dilation and curettage (D&C) can more quickly
clear tissue from the uterus.

A miscarriage doesn't happen all at
once. It usually takes place over several days, and symptoms vary. Here are
some tips for dealing with a miscarriage:

Use pads instead of tampons. It is normal to have mild or moderate vaginal bleeding for 1 to 2 weeks. It may be similar to or slightly heavier than a normal period. The bleeding should get lighter after a week. You may use tampons during your next period,
which should start in 3 to 6 weeks.

Take acetaminophen (Tylenol)
for cramps. Read and follow all instructions on the label. You may have cramps
for several days after the miscarriage.

Eat a balanced diet that is
high in iron and vitamin C. You may be low in iron because of blood loss. Foods
rich in iron include red meat, shellfish, eggs, beans, and leafy green
vegetables. Foods high in vitamin C include citrus fruits, tomatoes, and
broccoli. Talk to your doctor about whether you need to take iron pills or a
multivitamin.

Talk with family, friends, or a counselor if you are
having trouble dealing with the loss of your pregnancy. If you feel very sad or
depressed for longer than a couple of weeks, talk to a counselor or your
doctor.

Talk with your doctor about any future pregnancy plans.
Most doctors suggest that you wait until you have had at least one normal
period before you try to get pregnant again. If you don't want to get pregnant,
ask your doctor about birth control options.

After a miscarriage, are you at risk for miscarrying again?

Miscarriage is usually a chance event, not a sign of an ongoing
problem. If you have had one miscarriage, your chances for future successful
pregnancies are good. It is unusual to have three or more miscarriages in a
row. But if you do, your doctor may do tests to see if a health problem may be
causing the miscarriages.

Symptoms

Symptoms of a
miscarriage include:

Vaginal bleeding that may be light or
heavy, constant or irregular. Although bleeding is
often the first sign of a miscarriage,
first-trimester bleeding may also occur with a normal
pregnancy. But bleeding with pain is a sign that miscarriage is more likely.

Pain. You may have pelvic cramps, belly pain, or a persistent,
dull ache in your lower back. Pain may start a few hours to several days after
bleeding has begun.

Blood clots or grayish (fetal) tissue
passing from the vagina.

It is not always easy to tell whether a miscarriage is
taking place. A miscarriage often does not occur as a single event but as a
chain of events over several days. One woman's physical experience of a
miscarriage can be very different from another woman's experience.

It is normal to wonder whether you did something to
cause your miscarriage. It may help to know that most miscarriages happen
because the fertilized egg in the uterus does not develop normally, not because
of something you did. A miscarriage is not caused by stress, exercise, or
sex.

Exams and Tests

A
miscarriage is diagnosed with:

A
pelvic exam, which allows the doctor to see whether
the
cervix is opening (dilating) or whether there is
tissue or blood in the cervical opening or the vagina.

A blood
test, which checks the level of the pregnancy hormone called
human chorionic gonadotropin (hCG). Your doctor may
take several measurements of hCG levels over a period of days to learn whether
your pregnancy is still progressing.

An
ultrasound, which helps your doctor find out whether
the
amniotic sac is intact, detect a fetal heartbeat, and
estimate the age of the fetus.

If you have not had a blood test before, you may have one
to see if you have
Rh-negative blood.

Recurrent miscarriage. If you have three or more miscarriages,
your doctor can test for possible causes, including:3

Treatment Overview

There is no treatment that can stop
a
miscarriage. As long as you do not have heavy blood
loss, fever, weakness, or other signs of infection, you can let a miscarriage
follow its own course. This can take several days.

If you have an
Rh-negative blood type, you will need a shot of
low-dose
Rhogam. This
prevents problems in future pregnancies. Your doctor can do a
blood test to see if you are Rh-negative.

If a miscarriage is
causing intense pain or bleeding or is taking longer than you are comfortable
with, talk to your doctor about using medicine or surgery (such as a procedure
called
dilation and curettage, or D&C) to clear the
uterus.

Threatened miscarriage

If you have vaginal
bleeding but tests suggest that your pregnancy is still progressing, your
doctor may recommend:

Resting. You will be
advised to temporarily avoid sexual intercourse (pelvic rest) and heavy
activity. Your doctor may recommend bed rest. But most research shows that bed
rest does not prevent miscarriage.4

Taking progesterone. You may be treated with the hormone
progesterone to help maintain the pregnancy. This treatment, though, may serve
only to delay a miscarriage and has not been proved effective for preventing a
miscarriage.5

Avoiding NSAIDs. You will be advised
to avoid aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such
as ibuprofen. Use only acetaminophen, such as Tylenol, for nonprescription pain
relief.

Incomplete miscarriage

Sometimes all or some of
the fetal tissue stays in the uterus after a pregnancy miscarries. This is
called an incomplete miscarriage (incomplete or missed spontaneous abortion).
If your doctor determines that you have had an incomplete miscarriage, you will
have one or more treatment options:

Watchful waiting. This
period of waiting, called
expectant management, allows the miscarriage to end
naturally while your doctor watches for and treats any
complications.

Additional treatment concerns

If you are bleeding
heavily, you will be tested for
anemia and treated if needed.

In very rare cases, removal
of the uterus (hysterectomy) is needed for women who have severe,
uncontrollable bleeding or a severe infection that is not cured with
antibiotics.

After a miscarriage

If you plan to become pregnant
again, check with your doctor. Most doctors and nurse-midwives recommend
waiting until you have had at least one normal
menstrual period before trying to become pregnant.

Your chances of having a successful pregnancy are good, even if
you've had one or two miscarriages.

If you have had three or more
miscarriages (recurrent miscarriage), your doctor may suggest further testing
to help find the cause.

Home Treatment

There is nothing you can do to prevent
a
miscarriage. It is usually the body's way of ending a
pregnancy that has had a bad start, often at the earliest stage of cell
division.

It is important to be alert to the symptoms of a
miscarriage so that you can seek medical evaluation. If you are having symptoms
of a miscarriage, avoid sexual activity (called pelvic rest) and strenuous
activity until your symptoms have been evaluated by a doctor.

Call 911 or other emergency services immediately if you are pregnant
and you have
severe vaginal bleeding AND signs of shock. Early signs of shock include:

Lightheadedness or a feeling that you are about
to pass out.

Restlessness, confusion, or signs of
fear.

Shallow, rapid breathing.

Moist, cool skin or
possibly profuse sweating.

Weakness.

Thirst, nausea, or
vomiting.

Abnormal increase in heart rate.

Call your doctor immediately if you
are pregnant and you have any vaginal bleeding or
cramping pain in your abdomen, pelvis, or lower back.

Your doctor
may ask you to collect any expelled clots or tissue, if possible, in a clean
container. The clots may be examined to see if you have passed fetal
tissue.

After a miscarriage

The most common miscarriage
complications are excessive bleeding and infection.

It is normal to have mild or moderate vaginal bleeding for 1 to 2 weeks. It may be similar to or slightly heavier than a normal period. The bleeding should get lighter after a week.

Call 911 or other emergency services immediately if you have recently been treated for a
miscarriage and you have severe vaginal bleeding AND signs of shock.

Call your doctor immediately if you have recently been treated for a miscarriage
and you are experiencing:

Severe vaginal bleeding without signs of
shock. If your doctor does not respond immediately, or if you do not have a
doctor, have someone drive you to the nearest emergency
room.

Symptoms of infection. These symptoms include:

Fever of
100.4°F (38°C) or
higher.

Moderate to severe abdominal (belly) pain or
cramping.

Vaginal discharge that smells bad.

Coping with a miscarriage

It is normal to go
through a grieving process after a miscarriage, regardless of the length of
your pregnancy. Guilt, anxiety, and sadness are common and normal reactions
after a miscarriage. It is also normal to want to know why a miscarriage has
happened. In most cases a miscarriage is a natural event that could not have
been prevented.

To help you and your family cope with your loss,
consider meeting with a support group, reading about the experiences of other
mothers, and talking to friends or a counselor or member of the clergy. For
more information, see the topic
Grief and Grieving.

Your local bookstore
or library may have books on coping with miscarriage. Also, your doctor will be
able to address your questions and concerns about the miscarriage.

The intensity and duration of the grief varies from woman to woman. But
most women find that they can return to the daily demands of life in a fairly
short time. The loss and the hormonal swings that result from a miscarriage can
cause symptoms of depression, such as feeling sad and hopeless and losing interest in daily activities. It is important to call your doctor if you
have
symptoms of depression that last for more than a
couple of weeks.

A healthy, full-term pregnancy is possible for most
women who have had a miscarriage. This is true even after repeated miscarriages.
If you want to become pregnant again, check with your doctor or nurse-midwife.
Most health professionals recommend waiting until you have had at least one
normal menstrual period before trying to become pregnant after a
miscarriage.

Other Places To Get Help

Organizations

American Congress of Obstetricians and Gynecologists
(ACOG)

www.acog.org

March of Dimes (U.S.)

www.marchofdimes.com

Related Information

References

Citations

National Institute of Child Health and Human
Development (2010). Research on Miscarriage and Stillbirth. Available online:
http://www.nichd.nih.gov/womenshealth/research/pregbirth/miscarriage_stillbirth.cfm.

National Institute of Child Health and Human
Development (2010). Research on Miscarriage and Stillbirth. Available online:
http://www.nichd.nih.gov/womenshealth/research/pregbirth/miscarriage_stillbirth.cfm.

National Institute of Child Health and Human
Development (2010). Research on Miscarriage and Stillbirth. Available online:
http://www.nichd.nih.gov/womenshealth/research/pregbirth/miscarriage_stillbirth.cfm.

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